The "superbug," as it is dubbed, spreads through skin-to-skin contact and contaminated objects. Infection occurs when the bacteria enter the human host, usually through cuts or wounds. In rare cases, the organism is transmitted through the cough of a person who has respiratory-tract infection such as pneumonia due to MRSA. The bacteria used to afflict individuals with chronic illness or weak immune system, but now, even the healthy ones are at risk.

    Suddenly, MRSA has become a very real threat to everyone. Stories of its victims who died, many of them Americans, began to surface in mainstream media: an 11-year-old from Mississippi, a four-year-old preschooler from New Hampshire, and a 17-year-old football player from a Virginia high school. In Britain, A Filipina nurse was infected after giving normal birth in a hospital, where an MRSA outbreak occurred. She, too, didn't survive.

    The public may not have been aware of MRSA till last year, but the bug has actually been around since the early 1960s, when the first outbreaks occurred in European hospitals and certain Staphylococcus aureus strains were discovered to be resistant to penicillin and its molecular derivatives-methicillin, oxacillin and flucloxacillin, also classified as semisynthetic -lactams. Eventually, reports from other parts of the world revealed the presence of isolates that were no longer susceptible to all classes of -lactams, including cephalosporins, cephamycins, carbapenems, and -lactam/ -lactamase-inhibitor combinations. By the 1970s, even gentamicin proved to be ineffective against the superbug.

    In the Philippines, confirmed MRSA was first detected at the Philippine General Hospital (PGH) in 1987. The report was published by Almario and Velmonte in the Philippine Journal of Microbiology and Infectious Disease. According to Ontengco et al.'s report for United Laboratories on MRSA isolates from Filipino patients, 53 percent of the hospital-acquired S. aureus cases between 1996 and 1998 in PGH were "MRSAs with previous antibiotic therapy as a significant factor." The discovery supports what the medical community has long known: prolonged use of antibiotics can make bacteria resistant to the drugs.

    Dr. Celia Carlos, infectious-disease expert and chair of the Department of Health's Antimicrobial Resistance Surveillance Program since 1993, has been keeping track of MRSA's spread and growing resistance to a host of antibiotics. "MRSA is traditionally an infection acquired from hospital stay, very common in the developed world," she says. "But in the 1990s, we saw the first cases of community-acquired MRSA. That means it was seen in a person who has never been hospitalized in recent times-usually the reference time is one year-or does not have any chronic disease warranting frequent hospital visits, not necessarily being admitted."

    Together with Drs. Mediadora Saniel, Regina Berba, Myrna Mendoza, and Melecia Velmonte, Carlos initiated a study on community-acquired MRSA (CA-MRSA) in five hospitals in Metro Manila in 2006 to 2007. In the study, Carlos defined CA-MRSA as one that is "identified before 72 hours of admission to a hospital" and is found in a patient who does not have the following features of health-care-associated MRSA: history of hospitalization, surgery, or dialysis; residency in a long-term health-care facility within one year of MRSA culture date; and presence of IVs and catheters at the time of culture. These tubes, she explains, can cause breaks in the skin and mucosa which may allow entry of bacteria into the human host.

     "Symptoms of MRSA infection are like any S. aureus infection. If it's a wound, there's redness, pain, swelling, which may be small and can spread out rapidly. If it spreads too fast, it can invade the bloodstream and spread anywhere in the body, any organ," she continues. "We've seen S. aureus infection of the brain, the lungs, liver, and bones. Once it penetrates the skin and mucosal membrane, it can spread very fast, maybe in two to three days. And if it's uncontrolled, it can lead to a patient's demise."

    The good news, if it can be called as such, is that while there have been cases here of people who died from MRSA infection, they are mostly acquired in the health-care setting, according to Carlos.

    Nonetheless, treating and containing MRSA is becoming a major problem in the country. "Two years ago, our MRSA antibiotic resistance rate was only 20 percent," she says. It had remained at 20 percent since 1993, until a significant increase was noted in 2004. Now, the resistance rate stands at about 30 percent.

    "So in the span of two years, the rate grew by 10 percent, which is quite alarming," she continues. "In a study we did on CA-MRSA, we documented a rate of 14.7 percent in four tertiary care hospitals in Metro Manila in 2006. That's quite high. That means people who have not been exposed to the hospital acquired the infection even from just simple wound infections. That's a problem because intravenous vancomycin," which is the antibiotic of choice for treating MRSA "can be a very expensive treatment requiring hospitalization of the patient with CA-MRSA." Aside from vancomycin, there are new drugs for MRSA, such as linezolid, which is expensive as well.

    Carlos is also concerned by the growing presence of community-acquired MRSA pneumonia. "S. aureus isn't a common cause of pneumonia for kids or adults, but we've seen patients coming in from the community with S. aureus pneumonia," she says. "So when patients come in with very severe pneumonia, physicians have to administer antibiotics covering for MRSA as well at the outset, even before cultures are out, because if it's MRSA, it can rapidly infect other organs of the body such as the brain, causing meningitis; the bones, causing osteomyelitis; or blood, causing sepsis and septic shock."

    The best way the public can protect itself, she advises, is to clean wounds properly with soap and water, or antiseptics such as povidone iodine, if possible, and to cover it with sterile dressing. Physical contact with persons with open wounds should be avoided and personal items like razors and towels should not be shared.

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MRSA tends to spread among individuals who share items or stay together in close quarters-places like gyms, locker rooms, and schools. Some countries have reported outbreaks among athletes, military personnel, and prisoners. To prevent catching or spreading CA-MRSA (community-acquired MRSA):

• Wash hands frequently and thoroughly with soap and warm water, or use an alcohol-based hand sanitizer when water is not available.

• Do not share personal items, like razor, towel, and toothbrush.

• Wounds should be cleaned and dressed properly.

• Avoid touching other people's wounds and bandages.

• Cover your mouth when you or somebody near you coughs.

• Wipe down the seat and handles of gym equipment before you use them; do the same after you're done.

• If you have MRSA, iron your clothes, towels and sheets after washing them with warm water and detergent, or let them dry in a hot dryer; the heat helps kill the germs.

• If you have MRSA, use a disinfectant to regularly wipe down the surfaces you frequently come in contact with.

What is it?

    Methicillin-resistant Staphylococcus aureus is a virulent type of staphylococcus bacteria that is resistant to methicillin, oxacillin, and other commonly used antibiotics.